Saturday, January 18, 2014

Drug Treatment Centers Screening for HIV and Hep C

HealthlineNews

Why Aren't More Drug Treatment Centers Screening for HIV and Hep C?

Written by  | Published on December 24, 2013
    
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Screening for potentially deadly infectious diseases has dropped at for-profit opioid treatment programs over the past decade.
STI Testing
In spite of government recommendations for more widespread screening, the percentage of for-profit opioid treatment programs offering on-site testing for HIV, the hepatitis C virus, and other sexually transmitted infections (STIs) has dropped over the past decade.
This decrease in screening may unnecessarily delay the diagnosis and treatment of people enrolled in these programs and increase the chances that they will pass on infectious diseases to others.
“Opioid dependence—addiction to heroin, prescription painkillers, or both—is a very well-known risk factor for HIV, hepatitis C virus, and sexually transmitted infections,” says Marcus A. Bachhuber, M.D., of Albert Einstein College of Medicine, co-author of a Dec. 25 letter on STI testing at treatment centers in the journal JAMA.

Drop in Screening for Infectious Diseases

Using data from an annual survey sent to the directors of drug treatment facilities in the U.S., the researchers found stark differences among the levels of screening offered at public, nonprofit, and for-profit opioid treatment centers.
While more than 75 percent of public programs offered on-site testing for HIV, hepatitis C, and STIs during the 11 year study period, the percentage of for-profit programs screening for these infections declined during that time.
From 2000 to 2011, on-site screening for HIV dropped by 20 percent in for-profit programs, while screening for hepatitis C declined by 13 percent and STIs by 23 percent.

Rise in Number of For-Profit Programs

Opioid treatment programs “were among the first venues to offer HIV testing,” the study authors write, “and are more likely to offer HIV, STI, and HCV [hepatitis C virus] testing than other drug treatment programs.”
These strengths, however, are offset by the failure of many for-profit programs to offer on-site screening for potentially deadly infectious diseases, coupled with a rise in the number of these programs nationwide. 
Of the more than 1,000 opioid treatment programs in the U.S.—which provide treatment to more than 300,000 people each year—54 percent were for-profit in 2011, up from 43 percent in 2000.

Opt-Out Screening Has Little Effect

In 2006, the Centers for Disease Control and Prevention revised its stance on HIV screening to include opt-out testing for patients in all healthcare settings, including drug treatment programs.
Bachhuber and his colleague expected that the government’s new recommendation—HIV screening unless a patient specifically declines—would lead to more widespread testing for HIV in opioid treatment programs.
The survey showed that this was not the case, though it did not provide enough information to explain why the opposite trend occurred. 
“While it's not entirely clear why for-profit treatment programs are less likely to offer testing, it may help their bottom line,” says Bachhuber. “Offering testing is not required by federal and most state regulations, and may not be reimbursed for many patients (for example, those who do not have insurance or have poor coverage). For-profit programs may therefore cut costs and increase profits by not offering testing.”
The survey also didn’t look at whether patients were referred for off-site screening. However, this would likely have had little impact on the overall testing rate for HIV. In a 2012 study in theAmerican Journal of Public Health, researchers found that only 18 percent of people in drug treatment programs who were referred off-site for HIV screening received their results, compared to more than 80 percent who underwent on-site testing.
With rapid gains now being made in HIV and hepatitis C research and treatments, policy officials must determine how to reverse the decline in these lifesaving screenings in drug treatment programs.
“We are planning a follow-up study,” says Bachhuber, “to get at the specific reasons why more treatment programs don't offer testing.”
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gay men with HIV can now expect to live as long....

HealthlineNews

Life Expectancy for North Americans with HIV Reaches Historic High

Written by  | Published on December 18, 2013
    
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Some gay men with HIV can now expect to live as long as the average American, though non-white patients still lag far behind.
HIV Life Expectancy
A 20-year-old man with HIV who begins antiretroviral therapytoday had better start saving for his golden years.
Although HIV infection was once considered a certain death sentence, research published today shows that the average person infected with HIV in North America can expect to live to the age of 63. Gay men with HIV can expect to live even longer, to an average age of 77, according to the findings published in PLOS One.
In 2009, the average life expectancy for a 20-year-old American man in the general population was exactly the same—77, the study reported.
“[It is] nothing short of miraculous, given where we were 20 years ago,” said Dr. Mark Smith, who treats people with HIV and also serves as president of the California HealthCareFoundation. “It's a stunning success story for biomedical science and has contributed greatly to our understanding of other viruses and disease processes as well." 
The study looked at 23,000 HIV patients in the United States and Canada from 2002 to 2007. Subjects came from a wide range of racial and socioeconomic backgrounds. Intravenous drug users and non-white patients fared the worst, with life expectancies of 49 and 58, respectively.

Minority Health Gap 'Devastating'

Kyle Murphy, assistant director of communications for the National Minority AIDS Council, called the disparity in life expectancy between whites and non-whites with HIV “very real and devastating.”
“Across the board, communities of color fare worse than their white counterparts,” he told Healthline. “They are diagnosed much later and are less likely to be retained in care or to be virally suppressed.”
Dr. Joel Gallant, chair of the HIV Medicine Association, told Healthline he does not believe that race is an independent factor affecting life expectancy. “It's a proxy for more infections from drug use and later presentation to care,” he said.
The gay demographic, he said, tends to get tested for HIV regularly and to begin antiretroviral drugs immediately. Gallant, who said he sees HIV patients even in their eighties, noted that more people are being diagnosed at a later age, in part because older people tend not to get tested as often.
Early detection and treatment can now mean a normal lifespan for otherwise healthyAmericans. The study results show that people who begin taking antiretroviral drugs earlier live longer. By lowering the number of viral cells in the blood, antiretroviral therapy, or ART, also helps to prevent HIV transmission.

Prevention, Treatment Go Hand-in-Hand

“It turns out that with HIV, treatment is prevention,” Smith told Healthline. “That is, effectively treating HIV with modern antivirals not only prevents the opportunistic infections which used to kill people with the disease, but also substantially reduces further HIV infection."
Last month, the HIV Medicine Association released new guidelines for treating people with HIV. Now that so many patients are living into their sixties and seventies, it's necessary to focus on routine preventive care, such as cholesterol and blood pressure screenings and treatment.
Smith said he has one HIV patient who is 70 and just had a hip replacement. “He walks his grandkids to school," Smith said. "The irony is that now I have to worry about the same things I worry about with any 70-year-old—lipids, blood pressure, etc. Five years ago, frankly, I didn't spend a lot of time on mildly elevated blood pressure in people with HIV.”
The best way to live a long life is to start treatment early, take ART drugs consistently, and keep other health problems at bay, said Gallant.
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Kick and Kill Strategy

HealthlineNews

Scientists Try 'Kick and Kill' Strategy to Destroy HIV

Written by  | Published on January 17, 2014
    
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Can scientists "kick" dormant cells with HIV back into action to kill thevirus for good?
Kick and Kill
It's known as the “kick and kill” approach to combating HIV.
The idea is to “kick” quiet cells that aren't producing HIV, but are capable of doing so, into rearing their lethal heads. When they're not releasing the virus, there's no way to find and kill them. 
Standard HIV treatment, know as antiretroviral therapy (ART), keeps the dormant virus in these quiet cells from replicating. But once a patient stops taking ART, the virus comes roaring back.
Now, researchers at the University of North Carolina at Chapel Hill have made early steps toward a successful “kick and kill” treatment, using what's known as the “BLT mouse” model—a way of using humanized mice to study potential HIV therapies.

'An Incredible Model' for Studying HIV

Using BLT mice, J. Victor Garcia and colleagues at the University of North Carolina at Chapel Hill School of Medicine have found some success with the “kick and kill method.” The results of their work were published last week in the journal PLOS Pathogens.
“BLT” stands for stem cell "bone marrow, liver, and thymus," all of which come from humans. The mice had to be altered with human-like immune systems because the rodents could otherwise not be used effectively for HIV research, Garcia said. 
“When we looked more carefully at different tissues in the mice, to our surprise, the liver and lungs had human cells in them very much like humans,” Garcia told Healthline. “What was really transforming was that when we looked at two important organs—the intestinal tracts and female reproductive tract—both were humanized and had human cells.” 
That meant that researchers could induce HIV infection rectally and vaginally in the mice, just like in humans, Garcia said. “These mice turned out to be an excellent model, an incredible model, for studying HIV transmission.

A 'Guided Missile' 

Garcia and his colleagues, including Dr. David Margolis, teamed up with National Institutes of Health scientists Edward Berger and Ira Pastan. The NIH scientists created a genetically modified compound called 3B3-PE38. 
The 3B3 is an antibody that hones in on HIV-infected cells that are producing a specific protein on their surfaces. The antibody attaches to and then pierces the cells with PE38, a bacterial toxin.
Essentially, the antibody serves as a “guided missile” that carries the toxin “payload” on an HIV search and destroy mission, Berger told Healthline. 
For the study, the BLT mice were first treated with ART. Despite receiving high doses of medication, the virus remained present in all of the immune tissues the researchers analyzed. But when hammered with the 3B3-PE38 compound, evidence of the virus decreased six-fold.
Still, it did not completely wipe out the virus, meaning that it would eventually be able to multiply again. “It's not that we were able to offer a proof of principal that the kill step is viable, but a platform where we can test any strategy for HIV eradication,” Garcia said. “If a better 'kick' strategy comes around, we will be able to test it in this system.”

How Can Scientists Keep Kicking?

“How do we keep the kick going? That's what we don't know,” Berger said. 
Still, he said that the study does offer promise for those treated immediately after infection, such as the Mississippi baby born to an HIV-positive mother. In a controversial move, the clinician in that case immediately began giving the child high doses of ART.
The baby made global headlines, because 21 months after discontinuing treatment, active levels of the HIV virus could not be found in the child's body. Researchers are now using the term “remission” to describe the baby's condition.
Berger said the French VISCONTI study, in which people treated early with ART continued to have low viral loads even after treatment ended, also offers hope for the “kick and kill” strategy.
Margolis said the two-part problem of eradicating HIV—that the virus doesn't always express itself, and that we can't kill it all even when it does appear—stubbornly remains.
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